Webcast Series: Traumatic Brain Injury

(TBI) and Challenging Behavior

Ten Strategies for Preventing Challenging
Behavior after TBI
TBI Webcast Series
1. The Effects of TBI on Student Behavior
*2. Ten Strategies for Preventing Challenging Behavior after TBI
3. Using FBA to Understand Challenging Behavior after TBI
4. Planning Interventions for Challenging Behavior after TBI

Traumatic Brain Injury Webcast Series

Sponsored by: Wisconsin Department of
Public Instruction
Presenter:

Julia McGivern, PhD

University of Wisconsin Madison

Before Viewing this Webcast

Please view the first webcast in this series
* 1. The Effects of TBI on Student Behavior

2. Ten Strategies for Preventing Challenging Behavior after TBI

3. Using FBA to Plan Interventions after TBI
4. Planning Interventions for Challenging Behavior after TBI

Please download the following document which can be

found at http://dpi.wi.gov/sped/tbi.html
Interventions Across Stages of Recovery
*All names of students have been changed and identifiable
situations altered to protect student confidentiality
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Additional Resources to View

Level I Traumatic Brain Injury Training Modules
Module 1: Introduction
Module 2: Understanding TBI
Module 3: Returning to School
Module 4: Planning to Meet the Needs of Students with TBI
Module 5: Providing Positive Behavioral Interventions
Module 6: Supporting Students with Mild Brain Injury
http://www.dpi.state.wi.us/sped/tbi-trg-pres.html

TBI and Memory Module Webcast

http://dpi.wi.gov/sped/tbi-memory.html
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Overview of Webcast 2
Why focus on prevention?
Impact of stages of recovery from TBI on
intervention
Ten prevention strategies to use with students
with TBI

Three Approaches to Managing

Challenging Behavior after TBI
1. Focus on antecedents and prevention
Consistent with Positive Behavioral Interventions
and Supports (PBIS)
Add supports for student

2. Contingency Management Procedures

Focused on management of consequences

3. Combined prevention and contingency

management approach
Feeney & Ylvisaker, 2008
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Why focus on prevention first?

1. Prevention is easier
than intervention
2. Frontal lobe damage

3. Memory impairment

Student may not be able to

control behavior

May make use of

consequences of little value

4. Negative, reactive
procedures (e.g.,
punishment)
Lead to escalation of
behavior and impaired
relationships
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Stages of Recovery from TBI in

Moderate and Severe Injuries
Early stages

Middle stages

Later stages

Student may be confused,

tired, irritable, in pain
Student may still be confused,
impulsive
May have memory/executive
functions difficulties
Social problems may appear
Long-term deficits are more
apparent
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Prevention of Challenging Behavior

after TBI
The following strategies can be effective
The interventions seems simple, but must be
carefully thought out
They are best used when they are
identified and planned by teams
Consistency is important
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Strategies that Are Critical in Every

Stage of Recovery
#1: Positive and Supportive Staff Style

#2: Appropriate Instructional Match

#3: High Rates of Success

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General Proactive Strategies:

#1. Positive and Supportive Staff Style
Definition: School staff members are friendly and
positive in tone and appearance, use high ratio of
positive to negative communication, and avoid
nagging or repeated negative encounters
Example: Bills teachers and educational assistant
Maintain a friendly appearance (smiling, relaxed body
language), keep their voices at low or moderate levels,
and provide a high rate of positive feedback

Why is this an important strategy?

Students read the cues of staff members and respond
accordingly
Staff negativity can provoke disruptive and
oppositional behavior

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General Proactive Strategies:

#2. Appropriate Instructional Match
Definition: The academic skills taught and
expected to be learned match the students
instructional skill level
Example: Therese is in fourth grade, but her
reading skills are at the second grade level.
Her reading instruction is targeted at her skill level.

Why is this an important strategy?

Students become frustrated and act out when they
are unable to complete expected work
Students with TBI often have a scattered profile of
skills. It is critical to understand identify the skills the
student has and does not have
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General Proactive Strategies:

#3.High Rates of Success
Definition: A success rate of at least 80-90% in
academic activities
Example: Jose is able to complete 18/20 of the
problems on a math probe correctly
Why is this an important strategy?
After TBI students exhibit variability in performance
Students remain engaged when their success rate is
high
Students get additional practice of previously learned
skills
More difficult items can be gradually added
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Strategies that Are Especially Useful

Earlier in Recovery
#4: Redirection
#5: Classroom
Routines
#6: Graphic Advance
Organizers
#7: Naturally Occurring
Contingencies
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General Proactive Strategies:

#4. Redirection
Definition: Breaking the students psychological
set and re-engaging the student in a way that
eliminates the behavior
Example: Latoya is throwing sand in the sand
table
Redirection: Show Latoya a puppet she likes to distract
her and engage her in a positive interaction

Why is this an important strategy?

Used when the student is not able to benefit from
teaching new skills
Often used in early stages of a students recovery
Designed to reduce stress and prevent escalation or
behavior

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General Proactive Strategies:

#5.Classroom Routines
Definition: Classroom procedures that are consistent
over time
Example: in the morning the teacher uses a routine:
Students enter the classroom, put lunches in the lunch
bin, get out reading folders, and take folders to their
desks
Why is this an important strategy?
Students with TBI may be confused and agitated in
complex environments
Routines help reduce the complexity and make the
environment more predictable
Often most critical in early stages of recovery and with
severe injuries
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General Proactive Strategies:

Classroom Routines
Organizational routines
Problem-solving routines
Model problem-solving language and steps

Executive system routine: Goal-Plan-Do-Review

Brief discussion of goal(s) for the day and the plan
Execute the plan and briefly review how it went
Example
Ylvisaker et al, 1999
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General Proactive Strategies:

#6.Graphic Advance Organizers
Definition: Visual representations (e.g., photos, drawings)
of the schedule of activities or steps of a task
Example: Photographs of Terry in the morning routine
Entering the classroom, putting his lunch in the lunch bin,
getting his reading folder, and taking the folder to his desk

Why is this an important strategy?

Students with TBI often have severe memory impairment
They may be confused, disoriented, and apprehensive,
Students frustration and irritability decrease with cues to
expected behavior
Advance organizers help students learn and internalize
routines
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Examples of Items on Graphic

Organizers

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General Proactive Strategies:

#7. Naturally Occurring Contingencies
Definition: Build on the people/events already
occurring in the environment to maximize the
likelihood of student positive behavior
Example: Harry dislikes social studies
His 5th grade team assigned him to his favorite
teacher for social studies in a class just before recess

Why is this an important strategy?

This intervention does not require Harry or his
teachers to add an intervention
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Strategies that Are Useful As Expectations

for Student Performance Increase
#8: Behavioral Momentum

#9: Behavioral Scripts

#10: Opportunity for
Choice and Control
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General Proactive Strategies:

#8. Behavioral Momentum
Definition: Students positive behavior propels him/her
toward more positive behavior.
The teacher gives the student easily mastered and
enjoyable tasks
The teacher gradually adds in more difficult or disliked
tasks after the student is positively engaged

Example: Toby dislikes writing

Teacher engages him with coloring worksheets, then adds
a short writing exercise, followed by his favorite game (all
pictured on his advance organizer)

Why is this an important strategy?

Getting students started on a task is often very difficult
Beginning with an undesirable task can lead to disruptive
and oppositional behavior
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General Proactive Strategies:

#9. Behavioral Scripts
Definition: Routine sequences of behavior that are
repeated in certain situations; may also be verbal
scripts that help guide actions
Example: When going to gym class
Eric is expected to walk with both hands holding his
folder in front of him. He may also verbally guide his
behavior by saying, My hands are on my folder.

Why is this an important strategy?

Behavioral scripts help define expectations. They are
proactive in specifying a positive behavior
They facilitate practice of positive behavior
They provide positive behavioral momentum for the next
task
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General Proactive Strategies:

#10. Opportunity for Choice and Control
Definition: The student is involved in decisionmaking about activities by being allowed to make
choices or control aspects of the task(s)
Example: Jonah is allowed to
Choose between two activities or determine the order of
activities

Why is this an important strategy?

Students who are given some choice and control are
more likely to become and remain engaged
Giving some choice and control reduces power struggles
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Adolescents need some choice and control

General Proactive Strategies to

Prevent Challenging Behavior

Positive and supportive staff style

Appropriate instructional match
High rates of success
Naturally occurring contingencies
Redirection
Classroom routines
Graphic advance organizers
Behavioral momentum
Behavioral scripts
Opportunities for choice and control
Feeney & Ylvisaker, 2008; Ylvisaker et al., 1999

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Prevention Focus Consistent with PBIS

Positive
Behavioral
Interventions
and Supports

Approach is positive
Expectations are clear
Primary focus on
prevention
Use of FBA to understand
behavior
Data guide interventions
Interventions are evidencebased
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Next Webcasts in This Series

1. The Effects of TBI on Student Behavior
2. Ten Strategies for Preventing Challenging Behavior after
TBI
*3. Using FBA to Understand Challenging Behavior after TBI
Understanding Functional Behavioral Assessment (FBA)
Identifying factors that trigger and maintain challenging
behavior
*4. Planning Interventions for Challenging Behavior after TBI
Designing effective interventions to reduce challenging
behavior after TBI
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Questions or Comments?
Address questions or comments to:
sandra.corbett@dpi.wi.gov
For references cited in this webcast series, see
Webcast #4

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